再灌注治疗的 ST 段抬高型心肌梗死中的成纤维细胞激活蛋白成像：与心脏磁共振成像的比较。

Fibroblast activation protein imaging in reperfused ST-elevation myocardial infarction: comparison with cardiac magnetic resonance imaging.

机构信息

Cardiac Center, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing, 100020, China.

MR Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.

出版信息

Eur J Nucl Med Mol Imaging. 2022 Jul;49(8):2786-2797. doi: 10.1007/s00259-021-05674-9. Epub 2022 Jan 5.

DOI:10.1007/s00259-021-05674-9

PMID:34984503

Abstract

PURPOSE

The aim of this study was to explore the correlation of F-labeled fibroblast activation protein inhibitor (FAPI) and cardiovascular magnetic resonance (CMR) parameters in ST-elevation myocardial infarction (STEMI) patients with successful primary percutaneous coronary intervention (PPCI) and to investigate the value of FAPI imaging in predicting cardiac functional recovery, as well as the correlation between FAPI activity and circulating fibroblast activation protein (FAP) and inflammatory biomarkers.

METHODS

Fourteen first-time STEMI patients (11 men, mean age: 62 ± 11 years) after PPCI and 14 gender-matched healthy volunteers (10 men, mean age: 50 ± 14 years) who had completed FAPI imaging and blood sample collection were prospectively recruited. All patients underwent baseline FAPI imaging (6 ± 2 days post-MI) and CMR (8 ± 2 days post-MI). Ten patients had follow-up CMR (84 ± 4 days post-MI). Myocardial FAPI activity was analyzed for extent (the percentage of FAPI uptake volume over the left ventricular volume, FAPI%), intensity (target-to-background uptake ratio, TBRmax), and amount (FAPI% × TBRmax). Late gadolinium enhancement (LGE), T2-weighted imaging (T2WI), extracellular volume (ECV), microvascular obstruction (MVO), and cardiac function from CMR imaging were analyzed. Blood samples obtained on the day of FAPI imaging were used to assess circulating FAP, TGF-β1, TNF-α, IL-6, and hsCRP in STEMI patients and controls.

RESULTS

Localized but inhomogeneous FAPI uptake was observed in STEMI patients, which was larger than the edematous and infarcted myocardium, whereas no uptake was detected in controls. The MVO area showed lower FAPI uptake compared with the surrounding myocardium. FAPI activity was associated with the myocardial injury biomarkers T2WI, LGE, and ECV at both per-patient and per-segment levels (all p < 0.05), but was not associated with circulating FAP, TGF-β1, TNF-α, IL-6, or hsCRP. Among the CMR parameters, T2WI had the greatest correlation coefficient with both FAPI% and FAPI% × TBRmax. Baseline TBRmax was inversely correlated with the follow-up left ventricular ejection fraction (LVEF) (r = - 0.73, p = 0.02).

CONCLUSION

FAPI imaging detects more involved myocardium than CMR in reperfused STEMI, and is associated with myocardial damage and follow-up LVEF.

摘要

目的

本研究旨在探讨成功接受经皮冠状动脉介入治疗（PPCI）的 ST 段抬高型心肌梗死（STEMI）患者中 F 标记的成纤维细胞激活蛋白抑制剂（FAPI）与心血管磁共振（CMR）参数的相关性，并探讨 FAPI 成像在预测心功能恢复方面的价值，以及 FAPI 活性与循环成纤维细胞激活蛋白（FAP）和炎症生物标志物之间的相关性。

方法

前瞻性招募了 14 名首次发生 STEMI 并接受 PPCI 治疗的患者（男性 11 名，平均年龄 62±11 岁）和 14 名性别匹配的健康志愿者（男性 10 名，平均年龄 50±14 岁），他们均完成了 FAPI 成像和血液样本采集。所有患者均在心肌梗死后 6±2 天（基线）和 8±2 天（CMR）进行 FAPI 成像。10 名患者在心肌梗死后 84±4 天进行了随访 CMR。对心肌 FAPI 活性进行了程度（左心室容积中 FAPI 摄取量的百分比，FAPI%）、强度（目标与背景摄取比值，TBRmax）和量（FAPI%×TBRmax）的分析。从 CMR 成像分析迟发钆增强（LGE）、T2 加权成像（T2WI）、细胞外容积（ECV）、微血管阻塞（MVO）和心功能。在 FAPI 成像当天获得的血液样本用于检测 STEMI 患者和对照组的循环 FAP、TGF-β1、TNF-α、IL-6 和 hsCRP。

结果

STEMI 患者中观察到局部但不均匀的 FAPI 摄取，其范围大于水肿和梗死的心肌，而对照组则没有摄取。MVO 区域的 FAPI 摄取低于周围心肌。FAPI 活性与患者水平和节段水平的心肌损伤生物标志物 T2WI、LGE 和 ECV 相关（均 p<0.05），但与循环 FAP、TGF-β1、TNF-α、IL-6 或 hsCRP 无关。在 CMR 参数中，T2WI 与 FAPI%和 FAPI%×TBRmax 具有最大的相关系数。基线 TBRmax 与随访左心室射血分数（LVEF）呈负相关（r=-0.73，p=0.02）。